Provider Demographics
NPI:1578889655
Name:KRUTZLER, RANDI FATH (RPH MS)
Entity Type:Individual
Prefix:MRS
First Name:RANDI
Middle Name:FATH
Last Name:KRUTZLER
Suffix:
Gender:F
Credentials:RPH MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:124 N LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4415
Mailing Address - Country:US
Mailing Address - Phone:516-764-3200
Mailing Address - Fax:516-764-0403
Practice Address - Street 1:124 N LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4415
Practice Address - Country:US
Practice Address - Phone:516-764-3200
Practice Address - Fax:516-764-0403
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0333921835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist